Women in Scotland are being encouraged to give birth without doctors in Scotland using continuity of care as provided by midwives – that’s a massive change!
I am 100% for this initiative which is being rolled out across Scotland following the Best Start Maternity Review for the Scottish Government.
We know without a doubt, that continuity of care provided by a midwife and low-tech setting (such as home or a midwife-led unit/birth centre) are what makes a birth outcome much more successful – that is a birth that is SAFEST for baby and mum and where mums can reflect on positively – this was clear in the Birth Place Study and has since influenced the NICE guidelines.
Continuity of care has demonstrated:
- A substantial decrease in the stillbirth rate
- Increase in the women who are satisfied with their birth experience (information, birth place, preparation for labour, choice of pain relief)
- An increase in the number of women who birth vaginally
- Reduction in the number of women that need induction/augmentation
- Decrease in the use of analgesics
- Decrease in surgical interventions
- Increase in the number of women breastfeeding their baby
- Reduced hospital stay
In fact, there is only positives to continuity of care. And these are very similar to the findings around doula support – so we know that having STRONG EMOTIONAL SUPPORT is massively important.
There are so many issues, however, to overcome and to do it successfully, these need to be really addressed.
Change of working practices
- Having spoken to a number of midwives – they are very concerned about what this will mean for them
- In other countries where there is continuity of care such as New Zealand, the burn out rates are huge. Women may have better births but there is a cost to the workforce
- To ensure that these pilots are going to work and subsequently rolled out – support to the midwifery teams is the most fundamental element to get right
- There has been very little discussion with the midwives about what this means for them or how they will be supported
- There is currently little to no support for midwives to debrief or have holistic support for them – that needs addressed as that influences massively how they can support women
Fear-based culture of the NHS
- Health care professionals are trained often in supporting emergency situations – not physiological normal birth
- They are governed by fear – from professional bodies and litigation meaning they often cause more damage than good (see Lancet article – Too much too soon) – it will mean a massive shift in working practices and information
- Increasingly staff will be working out with their comfort zones
- I’ve heard so many times from women that community midwives have been very unsupportive such as “you have an inexperienced pelvis”, “you don’t want to birth at home”, “we might not make it in time”
- And I’ve heard consultants say “I don’t believe in natural birth” or “all first time mums need a hand to birth”
Fear-based culture of society
- Many women are petrified of birth
- A lot of pressure on partners to cover all the what-ifs – they really struggle to change their mindset about birth
- We culturally believe all women give birth in hospitals or else in the back of a car on the way to hospital
- Media is massively to blame – when have you ever seen a non-medically managed birth on the telly except on Call the Midwife?
High-risk women
- More women are being classed as high-risk such as those planning a vaginal birth after a caesarean, advanced maternal age, gestational diabetes, twins etc
- This means that the number of women that this new care model will affect will slowly get smaller
- There’s very little evidence about what the best care pathway is for women who are high risk
- Without a doubt, there are times that some women and baby will need life-saving care in the case of pre-term babies, babies with specific issues, mums with serious health issues such as pre-eclampsia/HELLP syndrome, placenta issues or other. And having the NHS and the amazing support of the highly skilled health care professionals is VITAL.
- However, there are many other situations in which healthy women are labelled high risk and end up with far too many interventions because they fit into a certain category rather than because there is an issue with them
- Does the high risk label automatically exempt them from low-tech care?
This is an exciting time for birth in Scotland and the UK. For the care of women to change in the short and long term – there are many discussions to be had and changes to be made to ensure that it is effective and long-standing and that it’s more than today’s new fashion.
The way women birth lasts with them a life-time and affects the relationships they have with their babies, their partners and the wider society. Birth matters. Let’s get this right.
If you’re pregnant and you’d like support to have the best birth possible – I provide one to one birth coaching, doula support or you can sign up to the Birth and Baby Academy where we talk all about the above.
Much love, Tricia xxx
Data Sources:
- Benefits of continuity of care (RCM)
- Medical interventions at birth has been increasing steadily over the last 5 years with over 70% (increasingly towards 80%) of women having interventions (RCM)
- 27% of women birth via caesarean (National Audit Office)
- Midwife-led care has the best outcome for women and babies, and homebirth is the safest birth choice for women in their second or subsequent pregnancy (Birth Place Study)
- The number of women reporting birth trauma including birth-related PTSD is around a third of births but the real number could be vastly higher (Birth Trauma Association)
- The biggest number of deaths around the perinatal time is suicide – a contributing factor of this is related to the way women have birth (Confidential Enquiry into Maternal Death)
